NICE outlines options for assessing fragility fracture risk

GPs should use either the FRAX or QFracture tools to estimate fracture risk in at-risk patients, NICE says.

GPs should use either the FRAX or QFracture tools to estimate fracture risk in at-risk patients, NICE says.

More than 300,000 people in the UK have fragility fractures each year. They occur most commonly in the spinal vertebrae, hip and wrist.

Fractures can lead to reduced life expectancy, with one in ten people with a hip fracture dying within 1 month, though most deaths are due to associated conditions and not the fracture itself.

While there are a number of therapies and treatments currently available for the prevention of fragility fractures for those at risk, identification can be imprecise.

This latest guidance recommends taking an assessment of fracture risk in all women aged 65 years and over and all men aged 75 years and over, and in women aged under 65 years and men aged under 75 years in the presence of risk factors.

These risk factors include; previous fragility fracture, current use or frequent recent use of oral or systemic glucocorticoids, a history of falls, family history of hip fracture and low BMI.

GPs should use either FRAX (without a bone mineral density BMD measurement) or QFracture, within their allowed age ranges, to estimate 10-year predicted absolute fracture risk when assessing risk of fracture.

NICE says to interpret the estimated absolute risk of fracture in people aged over 80 years with caution, because predicted 10-year fracture risk may underestimate their short-term fracture risk.

GPs are advised not to routinely measure BMD to assess fracture risk without prior assessment using FRAX (without a BMD value) or QFracture.

NICE also recommends measuring BMD to assess fracture risk in people aged under 40 years who have a major risk factor, such as history of multiple fragility fractures, major osteoporotic fracture, or current or recent use of high-dose oral or high-dose systemic glucocorticoids (more than 7.5 mg prednisolone or equivalent per day for 3 months or longer).

Dr Peter Barry, Chair of the Guideline Development Group that produced the guidance, said: "This guideline is an important step forward in the care for people at risk of fragility fracture.

"As well as clarity on the strengths of the QFracture and FRAX tools, the guideline also highlights common and important factors that should alert health professionals to consider risk assessment.

"Following the recommendations will help ensure that the most appropriate risk assessment tool is used for different people depending on factors such as their clinical history and age, so that well-informed decisions can be made about their future care."

A suite of support tools have been published to help implement this guideline, which includes an electronic audit tool, a costing template and a baseline assessment tool.